Intake form

Help us serve you better

Name *

Email address *

What services are you interested in?

Please select at least one option.

ADHD Assessment

Autism Assessment

Clinical Supervision

How did you hear about us?

What is your age range?

What challenges are you currently facing?

Have you previously received a diagnosis for ADHD or autism?

If yes, please specify the diagnosis and year received.

What are your primary goals for seeking assessment or supervision?

Do you have any sensory sensitivities we should be aware of?

Please describe any previous experiences with mental health services.

What is your preferred method of communication?

Additional questions or comments

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MindHorizon Clinical Services